March 1, 2017 -- Addressing a joint session of Congress, President Donald Trump laid out a now familiar game plan for repealing and replacing the Affordable Care Act and asked Republicans and Democrats to join forces, "get the job done, and get it done right."
So far, a unified Republican plan to replace and repeal the act has yet to materialize. Several bills have surfaced in the Senate; House Speaker Paul Ryan, R-WI, has promised to introduce a measure next month; and the Trump administration has said it would weigh in with a proposal.
In the Tuesday night speech, Trump also made a pointed pitch for cutting government regulation, particularly in the FDA, for the sake of developing new drugs. Noting that it was Rare Disease Day, he called attention to a 21-year-old woman named Megan Crowley in the Capitol gallery who was diagnosed with Pompe disease as an infant and not expected to live past age 5.
The congenital disorder is also called glycogen storage disease type II. Crowley's father was instrumental in developing a drug that allowed her to grow up to attend the University of Notre Dame.
"Megan's story is about the unbounded power of a father's love for a daughter," Trump said. "But our slow and burdensome approval process at the [FDA] keeps too many advances, like the one that saved Megan's life, from reaching those in need. If we slash the restraints, not just at the FDA, but across our government, then we will be blessed with far more miracles just like Megan."
Trump, who has not yet nominated a commissioner for the FDA, has said that as much as 75% of all government regulation could be erased without harm to society, a claim some have called unrealistic.
Guiding Principles for a Replacement Plan
Trump and his Republican allies in Congress have been discussing elements of a plan to repeal and replace the Affordable Care Act for weeks. On Tuesday night, the president pulled many of them together:
- A replacement plan should first ensure that people with pre-existing conditions have access to coverage, and that "we have a stable transition for Americans currently enrolled in the health care exchanges."
- The federal government should help Americans buy the coverage they want -- "not the plan forced on them by our government" -- with the help of tax credits and expanded health savings accounts.
- More control of Medicaid should be shifted from the federal government to the states. "We should give our state governors the resources and flexibility they need with Medicaid to make sure no one is left out," Trump said.
- Trump appeared to refer to medical liability reform -- now in the works in Congress -- when he spoke of "legal reforms that protect patients and doctors from unnecessary costs." In the same breath, he called for efforts to "bring down the artificially high price of drugs."
- Allowing the sale of health insurance across state lines, he said, will create more competition that will lower costs and improve care.
Trump's criticism of the Affordable Care Act was just as familiar as his talking points about replacing it. He said premiums for health plans on the act's exchanges have increased by double and triple digits. However, the Kaiser Family Foundation reports that most people in these plans receive premium tax credits, which have increased as well, shielding many people from the premium hikes. Trump also said that one-third of American counties have only one insurer due to a market exodus.
"Mandating every American to buy government-approved health insurance," Trump said, "was never the right solution for our country."
Democratic Response: Keeping the Commitment
In the official Democratic response to Trump's speech, former Kentucky Gov. Steve Beshear acknowledged that the Affordable Care Act needed repair.
"But so far, every Republican idea to replace the [act] would reduce the number of Americans covered, despite your promises to the contrary," he said, addressing Trump. "These ideas promise access to care, but deny the importance of making care affordable and effective. They would charge families more for fewer benefits and put the insurance companies back in control."
Before the act's passage, Beshear said, his fellow Kentuckians who lacked insurance coverage "woke up every morning and went to work, just hoping and praying they wouldn't get sick because they knew that they were just one bad diagnosis away from bankruptcy."
"In 2010, this country made a commitment, that every American deserved health care they could afford and rely on, and we Democrats are going to do everything in our power to keep President Trump and the Republican Congress from reneging on that commitment."